An Amber a Day: The Functional PCOS Podcast

Why PCOS Hormones are Not the Real Root: The Priority Pyramid- Season 4, episode 4

March 19, 2024 Amber Fischer, MS, CNS, LDN Season 4 Episode 4
An Amber a Day: The Functional PCOS Podcast
Why PCOS Hormones are Not the Real Root: The Priority Pyramid- Season 4, episode 4
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Ever wonder why your body behaves the way it does, especially when it comes to complex conditions like PCOS? Today I'll explain a concept called the Priority Pyramid, something I came up with early in my journey to becoming a practitioner that has helped me really look deeper into hormone issues to find the root cause.  I also discuss some philosophical things and fun stuff happening in my life in the first 20 minutes or so.  

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Speaker 1:

Hello, welcome back to An Amber Day, the Functional Nutrition Podcast. I'm your host, amber Fisher, and I'm so excited you're here. Today we're going to be talking about one of my favorite illustrative topics the priority pyramid. So if you don't know what that is, priority pyramid is a concept that I came up with when I was early on in my nutrition practice and I was trying to explain to people why their hormone symptoms were not really about their hormones and why they should care about things like their adrenal health or their gut health or their blood sugar balance, instead of just trying to figure out like what food can I eat to get better progesterone levels, or whatever it may be. So it works really really well, especially in cases related to PCOS, because so much of what drives our PCOS hormone imbalances are deeper physiological processes, metabolic issues and things like that. So I'm going to kind of explain how that works today and buckle up, because it's going to be a fun ride. Well, actually I don't know if you'll think that or not, but I think it's interesting and actually what the kind of cool thing about priority pyramid is. I sort of like came up with this concept on my own, but then, as I've taken more training in the functional medicine world. I see different iterations of the same concept around in lots of different forms and I think it's really cool because I think a lot of us who are meant to do this sort of systemic health and healing work where we're looking outside the box, we're looking deeper, we're investigating, we're getting to the core of issues and kind of rebuilding we're just sort of born with this kind of mind that likes to do that kind of thing and since that's fun for us, we spend more time doing it and then we end up helping people in that way and we all kind of have this same concept that's almost built into who we are as people. I think that's really cool. I really do believe that everybody is kind of meant for something and I believe that if you really are excited about something or something seems really wonderful to you, there's a good chance that you would probably be really good at that and there might be a place for you, whether that's like a career or a hobby or whatever. And I think a lot of people hold themselves back from even trying because they just assume back in the day.

Speaker 1:

Okay, let me give you a little personal example, back in the day when I was really interested in nutrition. I was researching it all the time, reading every book, like going on every blog. I thought, man, wouldn't it be cool to be like a nutrition podcaster and have a blog? Okay, keep in mind, guys, this was like 2012, 2013. So the social media world was landscape was very different. There was no Instagram influencer types, health influencer stuff going on. That kind of thing didn't exist. But there were blogs and there were starting to be podcasts, like the age of the podcast had begun, and I followed this podcast shout out to the Paleo for Women podcast. I think it's called the Empowered Women podcast. Now They've rebranded along the way because they kind of both of them got out of the whole Paleo sphere anyway, but I was really into that at the time. So I'm listening to this podcast all the time, obsessively listening to it.

Speaker 1:

I'm just like man, that is the job that would be the coolest thing to get, to be working from home, getting to do podcasts, getting to research the stuff that you're so interested in and talk about it all day and write about it, because I love to write. But I just thought that's a one in a million thing to be able to be successful in some sort of online career and not have to go to a nine to five job or whatever. That's impossible, that's not going to happen for me, it doesn't happen for but maybe one or two people, or maybe not one or two, but it doesn't happen very often, and so I told myself there's really no point in trying because it's impossible, and then fast forward and that's essentially my career. I'll be honest that the grind of the whole podcasting, making Instagram reels like TikToks, reading blogs, writing newsletters like seeing clients, all that kind of stuff is a lot more work than I. It's a lot more of a job than I originally figured. And making consistent money at it to where you can support your family and stuff Just a moderate income is a lot harder than it looks.

Speaker 1:

I remember thinking back when I first started my Instagram. I thought, man, if I ever have like 100,000 Instagram followers, I'm going to have it made. Those people must have so much money. They probably can just work when they want to and they get to work being creative and it's not so amazing. And then now that I'm there I mean I have, I think somewhere in the 80s 80,000 or so followers I realized like, oh actually, no, actually no, I mean I don't want to complain or anything, because I know I'm very lucky and I do make you know I can support my family most months, but it's a lot more of a grind than it looks like from the outside, which I think is good.

Speaker 1:

It's like not supposed to look like a grind from the outside, but anyway it is still my dream job in a lot of ways and I just sometimes, when I think back on that, I feel really grateful and it also helps me appreciate, like, when I'm going through like a hard month. Like you know, the last year or so the economy has been kind of weird and it has been more of a grind than it was previously, and so sometimes I can get a little down or start feeling, you know, like maybe I, maybe I'm not saying anything important anymore, like maybe maybe you know I've done everything I can do, or or what have you. And when I start feeling like that, I like to think back on. You know me back then thinking, wow, wouldn't it be cool to be like a blogger or a podcaster? And like here I am, I'm doing it. So anyway, that is a very roundabout story in which to illustrate my point, which is that I really do think that if there's something that you are excited about, it might be meant for you, and certainly this kind of work was meant for me, because I was just born with this sort of way of thinking about health. That was a little counter cultural, at least for the time.

Speaker 1:

It's interesting to watch the evolution of our beliefs and our opinions about health and nutrition, even since I've excuse me hopefully you couldn't hear me burping there. I don't know what it is about like recording a podcast, but I get like a nervous throat. Do you guys know what I mean? Like if you're going to have to give a speech or something and suddenly, like you've had, you've been normal all day, but then suddenly your throat is like itchy, like you're getting like a scratch in it and you're like then you start clearing it and then, anyway, my, it's like an anxiety throat response. I don't know, but it's very annoying. I'll tell you that much. So apologies, especially with this new microphone, I'm sure you can hear like every smacking sound my mouth makes, which is, for those of you who don't like those kinds of sounds is not going to be very fun.

Speaker 1:

Anyway, it's been so interesting to watch the change in opinions about health and nutrition, even since I started working in this field. Because back when I was like early on in my excitement about nutrition days, the concepts of functional health, nutrition, holistic health, like combining conventional and alternative methods, like Eastern and Western medicine all that kind of stuff was really kind of scoffed at. Like there are some things that now are just a given, like, for example, testing for vitamin D deficiency. Back when I started in nutrition, I had the hardest time getting doctors to run a vitamin D test and because they were like, oh, that's one of those woo, woo things, like that's one of those alternative things. Well, now it's like they do it automatically.

Speaker 1:

It's like almost part of regular blood work for a lot of doctors because, especially since COVID and the connection between COVID's symptom severity and vitamin D deficiency, like now it's like a standard thing, right. Same thing with, like something like fish oil. You know fish oil used to be really scoffed at, but then there were, you know, several studies that came out that showed, you know, benefits for heart health and things like that from fish oil. So now I have a lot of my clients be like, oh, I'm on a fish oil because my doctor said too, because, for you know, to help with my cholesterol or whatever. So it's like some of these things just become standard, they become part of a vernacular and they used to be seen as like super cuckoo, cuckoo bananas.

Speaker 1:

Oh, another example intestinal permeability or leaky gut. Even when I started in practice a lot of people still were like leaky gut, that's fake, like that's fake news, like that's not a real thing. And then you know, now we have so much evidence on the gut immune connection, the gut brain connection I'm looking at a book right now called the gut immune connection on my shelf over there. We have so much research on that and that's really where a lot of the oomph for current research is going. And you know as well, established now that this is a real thing.

Speaker 1:

So it's just funny, you know, I just think like and that's not to say that I've never been wrong, because I certainly have I have made some recommendations that I'm like, ooh, I cringe thinking about. In fact, I'm going through the archives of my TikTok right now because I'm looking for old videos that I've never reposted, to kind of do like from the archives series, give myself a break from content creation, and some of them I'm having to skip over because I'm like, yeah, no, I don't know if that I believe that 100% or I'd have to put caveats on it now that I didn't back then. So that's not to say that I'm like that myself or people in functional medicine are not wrong sometimes or don't exaggerate things sometimes or whatever. It certainly happens. But I do think there's like this kind of newer generation of health professionals that think differently about stuff, that think a little bit more expansively about certain topics, and that's good. That's a good thing because progress is a good thing.

Speaker 1:

Sometimes with progress comes a little bit of fumbling around. I'm not gonna wait. Who did I hear talk about this recently? Somebody said recently they're like I'm not gonna wait for research to catch up to what I know to be true, and that mindset can get dangerous. Like I could definitely see a way where that would not go in a positive direction. But for people on the cutting edge there is some truth to that. It takes like 25 years of buildup of research studies for things to get like really solidified in the conventional world. So it's kind of nice to be over here on the edge where you can try some stuff out and see how it works in real people and use your intuition a little bit more and stuff like that. Obviously, always by being safe, consult your doctor before anything, before taking anything on this podcast to heart.

Speaker 1:

So anyway, this disclaimer, we're gonna get into the topic today, I promise. But, as I said, I may or may not have said this in the last podcast or I might have edited it out, but I'm freeing myself up a little bit with the structure of these podcasts for this year. For the last couple of years I've been so like, let me follow this set list of things I'm gonna talk about. It's gonna be very educational. Not a lot about me, not a lot about my opinions. It's gonna be facts and evidence and whatever. And that served me for a time. But I'm kind of a little bit sick of that. I wanna just talk a little bit more about different stuff and go where my mind takes me. So we will get into today's topic. But that is a little bit about. That's a little bit of information on my opinions, about career choices and hobby choices, et cetera.

Speaker 1:

Speaking of that, this last weekend I had my dance team performance. I'm not sure if I've mentioned it yet on the podcast, but I have mentioned that I have been taking salsa lessons for the last eight or nine months and a couple of months into that I decided to join a salsa dance team at my dance school and this is like they have levels of dance teams or performance teams. So they have the freshman level, the sophomore level, the JV varsity level and then the all stars level, and I joined the freshman team obviously because I'm very new at this, but we have been practicing like hardcore practicing for months now and we had our big performance on Saturday night. I might insert a video of this in the YouTube version if you guys wanna see. Definitely it's not perfect and any of you who are salsa dancers that are more advanced are gonna see all the mistakes, but I'm so proud of myself and of all the people on my team who have become good friends over these months. You know it reminds me so much of summer camp or when I was growing up.

Speaker 1:

I was really involved in a church youth group like super involved. I was there like four days a week and it reminds me so much of that. Those were some of the best times in my life and so it's so exciting to be part of a group like this again. Anyway, we had our big performance. There was this whole crew. It was like a week-end-er event where there were all these special lessons being taught by this dance group from New York City, empire Mambo. So these are some of the most famous dancers of the style of dancing that I do, which is called onto salsa.

Speaker 1:

Anyway, these are some of the most famous dancers in the world. Apparently. I don't know anything about this stuff, but this is what I hear from people in the know. Anyway, they were here. They taught workshops which were incredibly hard, really fun, but nothing will make you feel more like a beginner than going to some of these workshops. I'm like, okay, I can hang a little bit with. Like I mean, I can hang for a while, but at some point I'm just like, okay, I'm so tired, anyway. So they did this week-end-er event and then there was a social dance in the evening and we performed during that social dance. My mom and dad came to watch, but I am so proud of myself that I did that and it was such a fulfilling experience, because dance is something that I have always wanted to do.

Speaker 1:

It's one of those things that I always felt would be so fun, but wasn't for me, and a lot of it stemmed from body confidence issues and just feeling like I was bigger than other people. And so because I was bigger than other people, I wasn't. I wouldn't be welcome in a space where it's traditionally very feminine or the dancers are very petite or they are very pretty or whatever. I just didn't feel like I fit in in that kind of environment or that I would be welcome there. And when I was younger, I really wanted to join the dance team at my high school but you had to go through pep squad first and in order to do all that, you had to try out. And so I was just too scared to even try out for pep squad because I thought I am too big for this. They don't want they're not gonna want a big girl on their pep squad. And looking back, that is so sad. It really is, because I really held myself back from doing that and I do think I would have really enjoyed it. I would have gotten a lot out of it and I'm sorry that I never did that.

Speaker 1:

But those body confidence issues were real. Some of it was from the times these were the early aughts. I think I would have had to try out for Pep Squad in 2002, 2003, something like that, and at that time, for those of you who were teens at that time, you remember anybody that was bigger than a size gosh, who even knows a size four that was considered fat in the public sphere. And there was this element of if you were considered fat, then you were not welcome in public spaces. You certainly weren't welcome to show your body off in some sort of sensual performance environment like dance. Some teams might have had girls that were a little bit bigger, but it was almost like this sort of embarrassment thing, like oh, there's the girl on the team.

Speaker 1:

So I was very aware of those standards at the time and I didn't want to rock the boat, I didn't want to be the token bigger girl and yeah, I don't know. Honestly, I wasn't even that big and it shouldn't have mattered anyway. Even if I was, wherever I fell, I should have been able to feel comfortable doing that, just because I wanted to do it and because it seemed fun and I could have been good at it. You know what I mean. So the whole thing is sad, but there's a redemption arc because as I grew up I got more comfortable with myself and especially as I kind of made peace with my PCOS and my insulin resistance and, to some extent, my weight, although I still struggle in that department, like I think many of us do. As I made more peace with that stuff and more peace with my body, I realized this was something that I could have done, I could have enjoyed and been good at.

Speaker 1:

And then the thing that I let hold me back for a while was my age, because I thought I'm too old to do all that. And it's so funny looking back. I remember when I went back to school to get my nutrition degree, I thought I was too old. Then I was like 25, and I thought I thought I'm too old to switch paths. It's so silly, looking back on it now that I'm 35 now and I realized at any point I could go back to school tomorrow, totally switch careers and have a very fulfilling career in a different field probably in multiple different fields if I wanted to. I don't want to go back to school because I'm sick of school, but you know what I mean. Time is on my side. I'm still very young. You can always change. You can always change direction.

Speaker 1:

So I let my age hold me back for a while and then, finally, this last year, when I was going to be turning 35, I would say probably since I turned 30, I've been on this kind of kick where I'm like okay, things that I wanted to do when I was younger, things that were scary for me, things that I have fears around, I'm going to push myself to do them. I don't know why I'm like that. I just am. If I feel, if I'm afraid of something, I'm like well, I better do it. I better do it so I'm not afraid of it anymore. I like challenging myself, like that Like is the wrong word. I just I feel a need to do it anyway. So that's why I started doing the pole dancing for a while. I did that for a few years. I really loved that and sometimes I really miss it. But once I got involved in dance, I just didn't have time or space. Like my muscles could not handle anything else and I'm really focused on this now. So, anyway, I turned 35. I'm like okay, this is it, this is the year I'm going to learn to dance, I'm going to do it and I'm going to have fun. And I didn't even know that dance performance teams were like a thing, but they are kind of a big deal. Like every dance school has performance teams and you know a lot of adults of all ages are on these performance teams and it's really fun and so I joined and anyway, the rest is history and performance on Saturday night went really well. So yeah, I don't know, I'm in a very good mood today, just coasting off the high from that experience still. But yeah, let's see how long have I been talking? Probably a while.

Speaker 1:

So let's get into today's topic, the priority pyramid. So to start off with, we tend to think about health in a certain way and I alluded to this earlier but we do tend to think about health as like a collection of separate experiences or separate systems. So, for example, we think the hormones are just about the hormones or we think that heart health is just about heart health. Like I had a lot of people you know come into my practice and say like, oh well, cardiovascular disease runs in my family, or type two diabetes runs in my family. And what people don't tend to realize is that just because something genetically runs in your family doesn't mean that you're fated to experience that thing. It does mean you're genetically more predisposed, but your environment and your lifestyle play the biggest role in determining how your genetics actually express. And some of that is out of your control. Because if you were raised for you know however many years in the type of home that is contributing towards the development of insulin resistance and you're raised on that diet and stuff, yeah, I mean you're like the odds are stacked against you early on, but there is so much that can be done to sort of reverse those things and genetics are not set in stone. They can express differently based on how well you take care of yourself.

Speaker 1:

So when we think about things like hormones, you know you're born with PCOS right, you have this genetic predisposition towards PCOS. But it's not just that you're born with extra testosterone or that you're born with cystic ovaries or something it develops with time because of a combination of factors that are not really hormonal at all. It's not like you just wake up one day you know you go through puberty. You wake up one day and you just have, like, high testosterone just because you're unlucky or because you're you know what have you? There's a combination of deeper factors, systemic issues that are happening, that are building up into this experience where your body is making more testosterone and then it is the testosterone, or, you know, high DHEA or whatever that are driving the cystic ovaries and then from there a lot of that stuff is a cascade effect, right? So once we have cystic ovaries, we end up making too much estrogen because we're not ovulating, and those little cysts are producing estrogen Because we're not ovulating, we're not making progesterone. So you know that contributes to the whole cycle of us not ovulating again and anyway, et cetera, et cetera.

Speaker 1:

We know, if you've listened to a few podcasts, you probably know the mechanics of how PCOS works. Thank you. A lot of the symptoms that we have are seem hormonal, right, like, so we'll have facial hair and so we think, okay, facial hair, that's something that men have, that's a testosterone thing, right? Hair loss, that's something that men deal with. That's probably a testosterone thing and, to a lesser extent, things like weight gain and stuff. Testosterone can cause people to hold weight in the middle. So, yes, that is what's going on, but also why.

Speaker 1:

The question to always ask is why is this happening? Why are my hormones out of balance in the first place? Because, as I said before, it doesn't just happen out of nowhere. So, to kind of illustrate this point to people, I explain this concept of the priority pyramid. And if you imagine a pyramid, think about it as like a levels of priority thing. It doesn't necessarily have to be a pyramid structure. It could be a different thing, but you know, it could be ladder rungs or whatever. But there is a top and a bottom to this. There's a accessory and a foundation. So on this pyramid we have three main levels and the top level is gonna be our sex hormones. So this is gonna be things like estrogen, progesterone, testosterone, all that kind of stuff, the kind of thing that we usually point to when we see PCOS symptoms and we say like, okay, these are out of balance, these are out of balance and that's why I have so many symptoms. But beneath that there are two other rungs that actually are the reason why these hormones on the top are out of whack in the first place.

Speaker 1:

So in the middle I tend to look at things like blood sugar balance. I tend to look at things like adrenal dysfunction. So the HPA axis, even the thyroid, can function here as well. Well, these are things that are not necessarily root cause issues, but they are driving symptoms. So they are both drivers of symptoms and also driven by other things. They're in the middle, they're kind of like they're the middleman. They are part of what directs the sex hormones to be out of balance, but they're also things that get out of balance themselves because of the deeper stuff.

Speaker 1:

And insulin could be argued, depending on who you talk to, that it might actually be down on this bottom rung that I'm about to talk about. I usually put it in the middle, though, because I find that a lot of insulin resistance. There's a genetic component to it, for sure, but that genetic component really can vary based on a lot of the factors deeper in the body. So what's the deepest rung? The deepest rung is gonna be our mitochondrial health, the health of our cells, our cell energy makers, and the health of our gut, the bacteria in our gut and the mitochondria themselves, which are kind of like the energy makers of our cells. Both of these things actually are connected to the way that our genetics express. So a lot of times we think about the gut as just being about our digestion or maybe just playing a role in like how inflamed we are or something, but gut health is actually really critical to the way that our genetics express as well, and so we have some research studies that show that if your gut health is out of balance, for example, you might be more insulin resistant or it might drive adrenal dysfunction or something like that, because it creates sort of an inflammation or an inflammatory environment the mitochondria.

Speaker 1:

If you go back and listen to a couple episodes ago, I did an interview with one of my friends, dr Kalia Waddles, who is a functional medicine physician. She is incredibly brilliant, really passionate and excited and she loves to talk about the mitochondria. So we did an episode on the mitochondria in PCOS, so I highly highly recommend listening to it. I know it sounds a little bit like boring, but I promise you it's not a boring interview, it's actually really cool. So, but the mitochondria are in charge of a lot of that inflammation that gets produced as well, and in genetic transcription, so like in how our genes reproduce. And yeah, there's just, and then also it's just like the energy that each organ that we have has the function to do its job correctly. So, for a mitochondria are like really damaged or they're really sluggish or there's just not enough cleanup work happening for those, then that feeds into every area of our body, including potentially our gut health, some might argue.

Speaker 1:

I asked Kalia this. I'm like what would you say is really like the true root of everything? You know, at least as far as we know in this current time, is it the mitochondria or is it the gut? Because a lot of people talk about the gut, and I certainly do a lot. I mean, I'm sure there's podcasts on heroin, like the gut is the foundation of everything. But you know, there's something to be said on both ends, like, and actually I think after I've kind of given it some thought and I think she said the same thing that probably it's actually mitochondrial health, that really is the true root of everything, because I mean, that's yeah, that's where the energy comes from for everything.

Speaker 1:

So, anyway, that's the pyramid structure. So why is it in a pyramid? You know what's the purpose of the pyramid format here? Well, the idea is to show you also that, along with kind of each rung, sort of causing issues in the rung, on top of it there's also this concept of, like, the body has certain things that it cares more about than others. So if our gut health and our mitochondrial health are not in balance, then the body can't like keep track of and manage and do a great job with the things on the middle rung. So, like our thyroid health might suffer here, our adrenal health might suffer here, because you know, this kind of inflammatory environment that gets created by issues on the deepest rung is not really conducive to great blood sugar balance or to great adrenal health, and so if those things by extension are out of balance, then it's really hard for the body to keep the hormones in balance. I mean, just anyone who's had a thyroid issue can tell you that your thyroid's out of whack. It obviously is going to mess up your blood sugar balance, is going to mess up your hormones. I mean this is one reason why a lot of women with thyroid issues, they get on thyroid medication and suddenly their fertility returns and they're able to actually get pregnant and maintain a pregnancy. They're actually able to lose weight again or do this or that.

Speaker 1:

So there's a lot that is driven by that middle rung that then impacts that top rung with the sex hormones and in PCOS. A good example here would be blood sugar balance and adrenal dysfunction. Both of these things can create more testosterone in the body. The insulin does this by directly driving testosterone production in the ovary. When insulin is a hormone, so when it's high it sends signals to the ovaries to make more testosterone, and then the adrenals can do this in more subtle ways but they can raise an androgen called DHEA which then can sort of create that cascade effect of cystic ovaries and those other. Dhea is an androgen, so it functions in much the same way as testosterone and the adrenals can also throw off blood sugar balance even more, creating a more insulin resistant environment which raises testosterone. So there are different methods there. I've also seen too that the adrenals being out of balance can of course contribute to ovaries or to egg health that's poorer, or to premature ovarian insufficiency, that kind of stuff.

Speaker 1:

So it all plays a role and it can drive issues at the top and there might be something to be said, for example, with something like estrogen kind of creating issues down at the base of the pyramid with gut health or with mitochondrial health, like, for example, a very estrogenic environment can contribute to high histamine production or it can also create imbalanced gut bacteria. But it's like a chicken or an egg situation and in this case I don't see a very many pathways for the estrogen to actually be the starter thing that then drives the gut health mitochondrial issue. I see it the other way around. Now I could be proven wrong on that, and I'm willing to be proven wrong. Maybe it's a circle, maybe it's not a pyramid, maybe it's like one of those little circular flow charts. I could see maybe a potential for high levels of plastic kind of exposures or endocrine disruptors, and then liver health issues, detoxification issues kind of playing a role there. But again, then that kind of connects back to the gut, because the gut is a big part of detoxification. Anyway, I'm going off on a little rabbit trail here where I'm working things out in my own mind, but for the purposes of today's podcast we'll call it a pyramid. And for this pyramid we have to understand that in order for us to really fix what's wrong at the top, we have to fix what's wrong at the bottom. It's just not going to work the other way around.

Speaker 1:

I can't put you on. Here's an example Vitex. Vitex is an herb that can help you create a little bit more estrogen at the beginning of your cycle and then contribute to you ovulating earlier, which then can help you make more progesterone and can kind of be supportive of more regular cycles. It tends to work fairly well in PCOS. I use it a lot with my clients. I like Vitex a lot, but if I don't have balance going on or at least improvement going on on the two bottom rungs of the pyramid and I try to put you on Vitex, it's not going to do anything.

Speaker 1:

A similar concept here would be birth control right, like yeah, we could put you on birth control and kind of artificially alter the hormones and your symptoms might reduce while you're on it, but go off your birth control and what happens? Right, any of you who have done this know it all comes rushing back. And this is something that really bothered me a lot in the early days of managing my PCOS, because I really wanted there to be something prescription that I could take that would help. And I really did believe, because I felt like I was led to believe this, but maybe I misinterpreted. But I felt like a lot of my health care professionals were like, ok, take birth control and it'll fix the issue. It'll like fix your hormones. And you know, I vaguely remember one of my doctors being like yeah, and then when, if you get off of it later, your hormones will probably like be balanced again, like they'll probably just adjust because of the birth control. That's not how it works at all.

Speaker 1:

It certainly didn't work that way for me and I think because of that I placed so much focus for so long on the hormones themselves that I really neglected those deeper issues, and so every time I would get off birth control I would create more issues for myself, because that kind of going on and off of birth control is really hard on the hormones of somebody who, like me, has, you know, some liver, sluggish liver issues. I had the MTHFR gene mutation, like there's some stuff going on that makes detoxification more difficult for me, not to mention like a lifelong struggle with like irritable bowel which, thank God is like actually has been under control for quite a while now, but you know it wasn't certainly at that point. And so to go on and off of birth control like that was essentially to put a lot of pressure on my detoxification systems, and you know that contributed to more and more estrogen dominance etc, etc. Eventually I developed endometrial cancer from this kind of high estrogen environment. I find it funny too that the treatment for the endometrial cancer was like high dose progesterone, you know, because that sort of balanced everything out. But anyway, that's neither here nor there.

Speaker 1:

What I'm saying is, if you hyper focus on your testosterone levels or your DHEA levels or whatever, and miss the bigger picture, the deeper stuff, then we can do that dance all day. It's not going to end in you having a more balanced hormone profile, and I think that's probably why, like there really isn't anything besides hormonal birth control, there's really no, like no doctors are prescribing I don't know like well, I guess they are kind of prescribing testosterone blockers now that I say that like spironolactone, right, but these things just kind of vaguely work. They don't really take care of the root and point being that there's really no good solutions for the hormone issues. That last right. And so that's where I think is really one of the big proofs or indicators that PCOS is so much more than just hormone imbalances. Because if it were just hormone imbalances, you know they'd put us all on, like we'd all be on spironolactone, hormonal birth control and maybe progesterone, on that combo for life and all would be well, right, we would be like perfectly fine, but no, we still have these sort of long term consequences and we have these issues where we get off of this stuff and it all comes raging back.

Speaker 1:

But what I think is the most concerning is the fact that, like, pcos stays with you even post menopause. You still have PCOS. You may not even have ovaries anymore. I don't have ovaries anymore. I had a total hysterectomy in 2020, but I still have PCOS. Because PCOS is really miss.

Speaker 1:

It's not named well, I mean, you don't even need polycystic ovaries to be diagnosed with PCOS. You can actually be diagnosed with it without polycystic ovaries. Look up the Rotterdam criteria for diagnosis. You only need two of the three. One of those three things is polycystic ovaries, but if you have the other two, you can have PCOS and not have PCO, not have polycystic ovaries, which is, you know, the disorder is misnamed or it's what is the word I'm looking for here. There's a better name. Misnamed is not the right word. Those of you who are into vocabulary, let me know what word I'm looking for here. But the name it's named incorrectly or inappropriately and I do think I thought I think I've heard talk about this, but I do think that, like, eventually, they were going to change the name of it.

Speaker 1:

But all that to say it follows you through life and, untreated, can result in higher risks of a lot of different stuff we talked last week about the higher risks of depression, anxiety. Even ADHD is more common in PCOS. Bipolar disorder is more common in PCOS. So there's mental health things. There's also cardiovascular disease, diabetes risk, you know, infertility like. There's just a lot of things that are risk factors beyond just oh, I have high testosterone so I have irregular periods and I grow facial hair so I just need to go get laser. You know what I mean.

Speaker 1:

And the mistake that I think conventional medicine makes is just looking at those hormones and being like, okay, what can I do to manipulate these? And then you know, there's some movement to manipulate the deeper issues, right? So metformin, of course, is going to manage insulin a bit better and that's a very common recommendation. On the supplement side, inositols work just as well as metformin, sometimes better, and those are typically recommended. Fish oils have some good research for PCOS. Inesidyl cysteine is my favorite supplement for PCOS. I mean, these things all work kind of on deeper issues and are a little bit more well known, but they're all just either band-aid approaches or they're helpful, but they're not going to really fix those deep, deep mitochondrial and gut health issues unless there's a fundamental change to the way we're nourishing ourselves.

Speaker 1:

Gut health can get out of balance for a lot of different reasons. Medications can contribute to that Shoot, even things like sedentary lifestyle and trauma can contribute to that, but the biggest contributor is going to be our diet, because the diet is what directly feeds the beneficial bacteria. So if we're not feeding those, then over time we're creating an environment in there that is pro more negative bacteria or that's just pro the proliferation of specific kinds of bacteria at the expense of others, and it's really about the balance between those, and that balance is created by fiber. Same thing with our detoxification systems, the gut being one of the major sites of detoxification for hormones. If we're not taking care of our mitochondrial health and we're not taking care of our gut health, then our body's going to really struggle with detoxification and elimination. This is why sometimes, if your cholesterol is high, eating more fiber can help. It can also help with your estrogen dominance issues. It's fundamentally about nourishment of those two areas.

Speaker 1:

When we're not taking care of mitochondria, which is also something that is done primarily through the ways that we nourish ourselves, then we get this increase in inflammation that's being created and an inability to clean that inflammation up because we're not feeding ourselves with things like antioxidants, which are going to clean up oxidants, we get reduced ATP production. Atp is like we talk about glucose being the food for the cells. Glucose eventually breaks down into ATP. Atp is the real food for everything. It gets a little bit technical there. This is where the Krebs cycle comes in. Just think about that.

Speaker 1:

If you were to hear that your body runs on fuel. If you are not able to create the fuel that you need, what's going to happen? You can't maintain everything. Some stuff is going to fall by the wayside. Your body, at its core, wants to keep you alive. That's priority one stay alive. Priority, like 857 or whatever, is reproduce. If your body feels that it is in a state where it can barely manage itself, where it can barely keep itself going, it's not going to have the energy or the resources to promote reproduction. There's some argument too for certain things like PCOS being evolutionary alterations to help the body reproduce during times when there was struggle.

Speaker 1:

Some people think that PCOS because it is this insulin environment, it's all these hormonal structures to get you to hold on to fat. A lot of people think that this might come from genetics of people who lived through famines, because, end of the day, yes, number one priority is keep yourself alive, but it is also important to maintain. The race must continue. People must continue to be born. It is very primal to want to pass on your genetics. Some people think these are adaptations for those kinds of environments, which means that when we're in an environment where we're not in a famine, then suddenly we have all the stuff at our fingertips and it all goes haywire. Now we have access to too much stuff. There's a lot going on here, but at its core, we have to manage our mitochondrial health and our gut health in order to have actual results with our hormones.

Speaker 1:

I think the point that I'm trying to make with this podcast besides just explaining this concept to you so that you can think more critically about nutrition recommendations that you see on the internet is that when you are managing your PCOS, don't just look at your hormones to determine if you're making progress. The thing about hormones is that they can take a very long time to respond to deeper changes. The deeper changes take a lot longer to really take hold than you would expect. When I'm working with clients, I'm not really expecting to see regulated periods, major hormone changes, major changes to facial hair production, things like that, until I've been working with a person for at least six months, but usually longer. It depends a lot on where the person is starting from. Sometimes I'll have people come in who are freshly diagnosed with PCOS and it develops later. They developed it in their mid-20s but they always had regular periods. As a teenager, let's say. Maybe they gained some weight or they've been struggling in that department and they went and got tested and then they get diagnosed with PCOS.

Speaker 1:

Those people tend to have the easiest time, relatively, with getting back to regular cycles because their body has that memory of having regular, balanced hormones before. Really, what I do with them is I help balance their insulin levels out, because usually it's the insulin that's triggering this wonkiness with the testosterone, and then they're off with their cycles. Regular cycles can vary. It can vary from anywhere from upwards of 35 days to months and months and months and months. It's my people who are like oh, I have a cycle. Some months it's 35 days, some months it's 45 days, some months it's always around a month to every couple of months. But it's very irregular in the sense that they don't know exactly when it's coming. It's not really on a schedule and the ovulation date gets pushed around. That's usually the influence of insulin. If we can manage the blood sugar better, suddenly their body's like okay, we know the rhythm, and it can go back to its rhythm again. Those tend to be the people who have resolution of their symptoms the fastest.

Speaker 1:

If you've been living with never having periods or having a period once every 10 months for your whole adult life and now you're in your 30s and you're trying to get pregnant and it's not working and you're just coming from a place where a lot more has built up, a lot more damage has occurred and it's going to take longer to regulate, if, if and this is just being totally honest here if we can regulate you fully at all. I don't say this to be defeating, but there is a collection of people, myself included, I believe. I don't know, because a lot happened to me Not to go into it, but a lot happened to me to where I wasn't. I really didn't have time to really test things, but I do think that there is a collection of people with the most severe PCOS symptoms who probably will never get like fully regular periods back. Their hormones will probably always be a little bit wonky.

Speaker 1:

But but that's not to say that they can't make major changes. I think they can make a lot of changes to how inflamed they are, to how insulin resistant they are, to how well they nourish themselves, to how well their cells are functioning, to how well the detoxification systems are functioning and getting a much better place with their hormone balance. But there may not be time before they hit menopause for them to actually like fully fix it, get to the point where they're having like 30 day cycles. I just think I like to be realistic and I think, with the way that we live now, the way that our world works, the way that our food system works, there's a lot stacked against us that is outside of our control. Think about things like soil quality. How much zinc are we getting from our fruits and vegetables that we were getting like twice of or three times as much back when our grandparents were eating fruits and vegetables? So we have to do a lot more now to get the same benefit.

Speaker 1:

The impact of endocrine disruptors is something that I think we're going to see more and more information on over the years, and that's something that's really in a lot of ways, outside of our control plastics in our environment and that is something that disproportionately impacts those with PCOS. So there's a lot of things that build up that we can't do much about. And if you are coming from a place where you've had a lot of years built up with these things without really knowing about the need to work on your nutrition because some of us are just we're not educated on that, just didn't know, or we knew but we didn't want to do anything about it at the time then it may not be the most feasible thing to get everything sorted out perfectly like some people can, and a lot just really depends on where you're coming from with that severity. I mean it's interesting because I've worked with a lot of people over the years. I've been in practice almost a decade now and mostly with those with PCOS. That's mostly what I've done. I've done some other stuff, like I'll do some stuff with autoimmunity. I do a lot. I have like kind of a little word of mouth thing going with like upper digestive stuff, like nausea and GERD. I do a lot with that food sensitivity, that kind of thing. But most of the work that I've done is with PCOS and it's usually my clients who haven't dealt with PCOS symptoms as long that have a better chance of getting them fully resolved.

Speaker 1:

No-transcript. So yeah, that it is what it is, and I say that from a place of love because I believe I'm one of those people as well. I mean, I ended up getting cancer at 25. So I don't think we were in, I don't think there were like great odds that I was gonna get like perfect 30-day cycles, but I didn't even really get the chance to try. You know, knowing what I know now, I would love to see what would happen, knowing what I know now, if I also didn't have the fear of getting cancer again and I could like try out stuff. I'd love to see what I could do. But I'm not gonna get that choice anymore because, you know, at this point I'm post-menopausal.

Speaker 1:

It is what it is and for some of us, some of you I know some of you listen to me you are already post-menopause as well, or you're in your early 40s, or you know you're at a place where it's like it's kind of it is what it is situation, and now we're just doing cleanup work. We're doing what we can right. That's okay too. There's still a lot of value in that because, like I said before, this is something that is gonna affect you. Pcos stays with you throughout your whole life. So at that point when we're not looking at, let's try to get totally regular periods. Now the goal post changes and it's let's have a better quality of life as we age, let's reduce our risk of long-term health complications, let's keep our hearts healthy, let's keep our bone density, you know, in a good space. So our goals change. But at the end of the day, to do any of that stuff whether it's regulate periods or reduce our risk of chronic health issues as we age it starts by taking care of the mitochondria and the gut. Now, how do we do that? There's a lot to that.

Speaker 1:

I may have to make a part two to this podcast, because I'm looking at the time and I've been recording now for like an over an hour. Obviously, I'm gonna edit it, so it's not gonna be an hour long that you're listening, but still, I've been recording a long time and I think this is gonna be a long one. So I'm not gonna go too much into depth today on like what we can do. I might make a part two, but what I would suggest and I'll try to link to some of these in the show notes is go back and listen to my podcasts that are specific to gut health. Listen to that one with me and Kalea that talks about mitochondrial health, listen to the one about gut health and then I may do another one specifically about supporting your mitochondria. I actually already have something like that. I'll look. Anyway, you will see. You'll see in the next few episodes if I end up doing that or not.

Speaker 1:

But big things more fiber, that's for your gut. More antioxidants, that's for your mitochondria. Exercise for both. So antioxidants are gonna be like your PCOS superfoods I do have a podcast on the PCOS superfoods, so highly recommend listening to that. Your leafy greens, your veggies, your even things like dark chocolate stuff that's high magnesium, like peanut butter, all that kind of stuff, mostly your veggies and your fruits, right, like your berries all that kind of stuff, the stuff you know is healthy for you. That's gonna support your mitochondrial health. With mitochondrial health we always say eat the rainbow. So eat lots of different colors of fruits and veggies For gut health.

Speaker 1:

We're talking fiber, so that means more obviously vegetables are gonna contribute to that. But also we're looking at things like legumes, so beans in your diet being things like whole grains in your diet. Being careful with grains, obviously, because too many grains or an imbalance between grains and protein and fats can create more of an insulin response, which could be negative here. So being careful with grains. However, whole grains are, and particularly legumes are where we're gonna get a lot of our fiber, but it doesn't have to be a lot Like. I would definitely look at how much fiber are you getting from these different things and plan accordingly. So we're looking to get at least 30 grams of fiber a day. But honestly, if I'm being totally honest, I think with PCOS we'd probably benefit from more. But work your way up. If you're gonna try it, work your way up, because if you do too much fiber too fast you'll make yourself constipated and miserable. Even things like psyllium husk a little psyllium husk to bridge the gap can be helpful here, but it should mostly come from whole foods, because then you're gonna get those mitochondrial benefits as well. So you're kind of like killing two birds with one stone.

Speaker 1:

Exercise for both. Exercise, because exercise helps with mitochondrial repair. It also helps with bacterial balance in the gut. Really cool. There was a study done that showed that exercise on its own, with no diet changes altered the gut bacteria balance. So exercise for both, because it's gonna help with not only with repair for mitochondria, gut health balance, but it's also gonna help with insulin, which is then gonna help with the amount of cleanup work that has to be done. It's gonna reduce that. So exercise is key for both.

Speaker 1:

I do have planned to do an exercise and PCOS podcast very soon. It's in my little notebook here and I wrote it down so I have to do the planning for it and pull studies and things like that. But that is coming. So, yeah, those are the big things and I hope this was interesting for you. Hope it helps. Thanks for listening to my thoughts at the beginning about dance and all that kind of stuff. I hope you enjoyed this. But definitely reach out if you have questions. There's a form you can find in the link tree. That's questions for the podcast and I love to answer questions from you guys and I'm planning to do more of that this year.

Speaker 1:

And if you have not left a review on iTunes, but you've reached this point in the podcast, I know that you are a solid listener. You are a person who is very close to my heart, because not many people make it to the end of these. So please, please, please, please, please, do me a favor, leave me a review. I don't know Reviews. Everybody's entitled to leave the review that they want, but I'm really trying to get more five-star reviews, because lately I've got a couple of one-stars which has made me sad. So, anyway, you know I'm not for everyone, but if you are a listener and you've gotten anything out of this podcast, please do me a favor. The way it helps the most is if you rate it on iTunes. So it's kind of annoying because you have to like go find me on iTunes and then rate it from there. You can also rate me on Spotify, but I think it matters more if you rate me on iTunes, from what I've read. Anyway, thank you guys. Talk to you soon. Bye.

(Cont.) Why PCOS Hormones are Not the Real Root: The Priority Pyramid- Season 4, episode 4